One of the most amusing occurrences during the course of an illness is the spectacle of having a patient who is vomiting a greenish substance. For some obscure reasons, it causes relatives some genuine concern when they see their loved ones vomiting such substances and they are often quick to rush over and say, “he is vomiting green.” This kind of vomit is known as bilious vomiting, so described because yellowish-green or greenish yellow is the colour of bile. Bilious vomiting means that a person’s vomit is either yellow or green or a mixture of the two colours. This may mean that the person who is vomiting has a blockage somewhere along their gastrointestinal tract or is vomiting persistently despite having an empty stomach. In newborns and infants, greenish vomiting is usually the earliest symptom of an obstruction in their intestine. It is therefore important that parents and other caregivers who observe this kind of vomit during the first three days of life should know that it connotes something very serious and should waste no time in seeking expert healthcare. This must be taken as an emergency and there should be no dilly-dallying with respect to what has to be done. The suffering baby or child should be taken to an emergency room where paediatricians can be found.
Bile has a bitter taste unquestionably, and whoever is suffering from this kind of event is definitely not at ease. What it often means is that something is preventing bile from passing normally through the intestinal tract in a direction that takes it away from the stomach and towards the anus. One of the most common causes of this type of problem is seen in newborns where due to the result of an obstruction in the duodenum that such babies are born with, bile does not flow normally in the direction described above. In such babies, the duodenum has not properly developed and is therefore abnormally missing some parts or is unusually narrow such that bile is unable to pass through. The duodenum is the first part of the small intestine after the stomach. It, therefore, expands abnormally just as the stomach also expands and both then become reservoirs of bile from which the baby vomits repeatedly often after the first feed during the first or second day of life. Other factors that may result in bilious vomiting in children are such problems as a gallstone within the common bile duct, jejuno-ileal obstruction, and Hirschsprung’s disease; and in adults would be such problems as gallstones, early morning sickness in pregnant women, and small bowel obstruction due to tumours and blockage on account of foreign bodies.
Vomiting is a common phenomenon, and most individuals would experience it at some point in their lives. For many people, it is one of the most common features they can have once they are unwell. However, most of those times, the kind of vomiting such people experience would be non-bilious vomiting which means that it is not containing any bile. Some causes of this kind of vomiting would be from food poisoning due to infections, pregnancy as well, the use of certain types of drugs such as metronidazole, and such events as appendicitis. But it is important to know that there are other factors which could affect the colour of vomit depending on the type of food eaten, how much water was taken and the composition of what was consumed in terms of food and drink, how frequently the person vomited, and the amount of food that was consumed. The other important fact that is found in association with this problem is that especially in relation to how many times a person has vomited, dehydration, confusion and even a coma can result in a matter of hours. In situations such as these, and especially in adults, the use of an anti-emetic medication can be rapidly effective in controlling symptoms while the administration of a drip and intravenous antibiotics will help to replace the fluids being lost and to kill off the bacteria causing the problem.
The usual problems associated with bilious vomiting, however, may not be as profound as what has been described above because the reservoir for bile is a lot smaller than such a situation which would include the small intestines. In the newborn in particular, and also in infants, bilious vomiting is taken very seriously because it is frequently due to an obstruction. As a result, doctors waste no time requesting X-rays, abdominal scans and more depending on the availability of such infrastructure and their proximity to the hospital. In the end, the treatment of this condition depends on the cause. The result of treatment will also be dependent on the cause, and the investigations will help determine what may have led to it. Apart from the use of drips, antibiotics and antiemetics above, an operation can be conducted to remove a gallstone or to relieve an obstruction, and to perform an appendectomy to remove a diseased appendix. Therefore, it is important for the sick person or the people providing them with care to be able to accurately furnish the attending healthcare staff with a correct description of the colour of vomit. Such descriptions help point clearly towards the possible cause of the vomiting being described, or rather the location of the problem. When bilious vomiting is the main presentation, especially in a child who is unable to express itself, it must be seen as concerning.
The diagnosis of the causes of this seemingly innocuous condition may be difficult sometimes. In adults especially, doctors will need to explore a wider range of possible causes and they will need to ask about the history of any recent illness, or if women request a pregnancy test. This is important because not all the time a pregnant woman is aware that she is pregnant nor is it always the case that she knows and is willing to be truthful about it. In either of the two cases, a pregnancy test will reveal what is responsible for such vomiting.In babies, if a routine x-ray of the abdomen and an abdominal ultrasound scan fail to reveal the possible causes, a special imaging technique that involves drinking a contrast solution or injecting a dye into a vein such that a series of x-rays are then taken to determine where the problem lies is often considered. It is absolutely important to determine what the correct diagnosis is before proceeding to perform an operation so parents need to understand that they must trust the healthcare team and be patient while these possible causes are being unearthed. As emphasized previously, a correct diagnosis is what all the subsequent treatment depends on. In an adult or older child who is not deteriorating, and in whom the possible diagnosis is not reached, supportive care can be offered while close observation is given until the picture is clearer. Sometimes, that is all that is required because soon enough, the patient can start to improve.
